1. Technical Field
The present disclosure relates generally to surgical masks and drapes, and more particularly to protective surgical masks and drapes that can forestall a flash fire accident during facial and head operations during which electrosurgical or laser devices and supplemental oxygen are in close proximity.
2. Related Art
Operating-room fires are associated with significant morbidity and even mortality. Despite awareness and other preventative tactics, many operating room fires are reported each year. The medical literature is replete with articles highlighting the risks. Face and head surgeries are, more often than ever, being performed with electrosurgical or laser devices in combination with nasal cannulated oxygen, making the prospect of fire a serious and growing concern. Although drastically underreported, the Emergency Care Research Institute estimated that between 200 and 240 surgical fires occurred in the United States in 2012, making the frequency of their occurrences comparable to that of other surgical mishaps, such as wrong-side surgery or retained instruments.
For surgical fires to occur, three environmental conditions must be present simultaneously: an oxidizer (eg: oxygen, nitrous oxide), an ignition source (eg: electrocautery, electrosurgical devices, lasers), and a fuel (eg: alcohol-based prepping agents, aerosols, oily substances, hair, surgical gowns, drapes, towels, hoods, masks, tissues). During many surgeries, especially those performed with the patient under conscious sedation, patients are routinely provided with a supplemental oxygen supply via a nasal cannula or a mask. Of reported hospital fires, nearly three quarters have been identified as having an oxygen-rich atmosphere as a significant contributing factor. Further, the threshold for combustion of materials that may not normally be expected to combust in ambient air may be breached with oxygen flow rates as low as 2 liters per minute. Oxygen supplementation is commonly given at 2 to 6 liters/min. An enriched oxygen environment increases the flammability risk of human tissues as well as drapes, cleansing solutions, and other materials common in the operating room. Oxygen tubing itself may even ignite and can create a dangerous blowtorch effect if the oxygen is still flowing.
One general tactic for preventing surgical fires during the use of supplemental oxygen and an electrosurgical or laser devices which could function as an ignition source is to cut off the flow of supplemental oxygen at least one minute before the use of those devices, to allow lingering pockets of air with elevated oxygen concentration to dissipate, and to not restart the flow of supplemental oxygen until the electrosurgical or laser device is no longer being used.
However, this tactic is not always flawless, as the continued and growing prevalence of surgical fires shows. For example, the delivery of supplemental oxygen during a surgery performed under conscious sedation will usually fall under the supervision of an anesthesiologist, while the electrosurgical or laser device will be used by a surgeon, both of whom are very focused on their own individual tasks. This presents a situation where miscommunication between the surgeon and the anesthesiologist may result in a failure to cut off the supplemental oxygen supply at least a minute prior to use of the electrosurgical or laser device, or at all. This risk may be further exacerbated in surgical settings where these devices may be used frequently and often in response to rapidly changing patient conditions, such as abrupt bleeding. Additionally, in patients with poor cardiopulmonary function, discontinuing the supplemental oxygen supply at any point may be highly undesirable.
Other tactics for preventing surgical fires face similar challenges. For example, extending the nasal cannula prongs with nasopharyngeal tubing may mitigate some risk due to the supplemental oxygen being delivered deeper into the patient's respiratory tract. However, this tactic is likewise limited, because it may result in sub-optimal oxygen delivery due to additional patient discomfort and impaired nasal air exchange. Further, during surgeries directly performed on a patient's upper respiratory tract, this may further heighten the risk of surgical fire, as the supplemental oxygen may become even more concentrated in the upper respiratory tract, and the nasopharyngeal tubing may, in areas of high oxygen concentration, be set aflame.
In view of a foregoing, there is a need in the art for a surgical mask for surgical fire prevention.